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Thursday, September 20, 2012

great and lesser expectations

I had Cal three weeks after starting my training in anesthesia--a highly conspicuous move that I think indelibly branded me for the rest of my academic career as "that pregnant resident"--so I think it's fair to say that I have some insight into the assumptions that people tend to make about people mixing family with a career in medicine.

In most ways I imagine it's not unlike mixing family with any intense or high-powered careers--look at all talk that Marissa Mayer's pregnancy incited after she was named the new CEO of Yahoo. (Aside: I'm not saying that my career is anywhere near as high-powered as that of Marissa Mayer, just that the case is emblematic). Particularly in the field of anesthesia, where I'm in the room but often lurking in the background or behind a drape, I've heard a lot of conversations about medicine, other physicians, and things that fall in the rubric of "lifestyle choices"--conversations that maybe weren't meant for me to hear. But as a result, and as a result of living my own life, I can say for sure that women in medicine (physicians in particular) who choose to have children during the most active parts of their careers suffer under what I'd describe as a handicap of perception.

Perception. Not an actual handicap, but one of perception. There's a Chinese saying that my dad always uses that roughly translates to, "When you're walking through someone else's pumpkin patch, don't bend over to tie your shoes." (OK, that's a very rough translation--I don't think the parable from which the saying was taken originated during a time when shoelaces were a particularly popular feature of Chinese footwear.) What it means is: if you're in a setting that breeds suspicion, try hard not to do suspicious-looking things, no matter how innocent they actually may be. Because you may be just tying your shoes in the middle of that pumpkin field, but a casual observer might be inclined to think you're actually stealing those pumpkins.

I think that in medicine (and perhaps in the working world in general but what the hell do I know, I've never had a real job doing anything else) people are quick to assume things about working mothers, not too many of them flattering. I'd like to say "working parents" because believe me, I'd love for us to get to a point where there is actual gender parity on the issue (to be fair, I do think that Joe and I do have gender parity when it comes to parenting, but...we do have to leave our household occasionally and interface with the world) in the year 2012, this is still more of an issue of perception for working mothers. The following is a list of some of the things that some people are quick to assume about women with children who work outside of the home.

1.) We don't work as hard.

2.) We complain when we do have to work as hard as everyone else.

3.) We want special favors and allowances in the workplace because having kids somehow entitles us to them.

4.) We are unreliable because something's going to come up with our kids and we're either going to leave our co-workers with the extra work, or sometimes leave our jobs entirely.

5.) We just don't care as much about our jobs as our counterparts.

5.) All this is somehow inevitable.

The problem with other people's perception, especially those colored by preconceived notions, is that there's very little that you can do about it. It has very little to do with you, and sometimes even very little to do with reality itself. And that perception can be insidious, like a Chinese finger trap--the harder you struggle against it, the tighter it binds you. (Yes, again with the Chinese. WE HAVE A RICH CULTURAL HISTORY, OK? Actually I have no idea whether Chinese finger traps are actually Chinese, or just "Chinese," like fortune cookies or General Tso's chicken, but whatever, it's not germane to the metaphor.) You want for all the world to defy the lowered professional expectations that people have of you, to prove them wrong, but sometimes it feels that the harder you try, the more you're reinforcing them nonetheless.

So what I think a lot of female physicians with kids do--and what I know I certainly do--is overcompensate. You do it all and then some. You work even harder. You try to never complain about your schedule or your hours while you're at work. Not only do you not ask for special favors, you embrace situations that allow you to prove that fact. In other words, you try to work as much and as hard as everyone else, and then you go a little bit farther, just to make sure. You try to be above reproach.

Sometimes this works. Sometimes it doesn't.

I think often now about Michelle Obama, particularly during the president's first presidential campaign, and how hard she and her team had to work to control her image. The reasons people might have a negative impression of her are perhaps multifactorial and not entirely flattering of a portion of the electorate, but there seemed a point where every little thing she did or said, no matter how innocent, was misconstrued as playing right into her detractors' expectations. (The endearing but now notorious fist-bump comes to mind.) Sometimes it feels that way to me too. Representing not only myself, but working mothers in medicine as a group, I am very aware of trying to present myself, present all of us, in the best possible light. Again, overcompensating. I think this explains a lot of my personality at work, which I have often classified as "aggressively pleasant." As in: I will be easy-going and pleasant to work with if it kills me.

Sometimes this gets pretty tiring.

I also will note that there's a segment of people who will respond to this blog entry with the opinion that I and others like me are far too sensitive about these issues, reading meaning into things that have no meaning, turning mountains into molehills. I am perfectly fine with people responding however they want (as someone who has been writing online for more than a decade, I think that if it's your right to publish something online it's the right of your readers to respond, even if they disagree with you) but I also think that actually being a working parent in medicine, a working mother in particular, lends you a perspective that you don't have access to otherwise. So saying that we're overly sensitive to the issue of low expectation or perception bias is, to me, a little like a straight person saying to a gay person that they're being too sensitive about homophobia, or a white person saying to a Latino that they're too sensitive about racism. Or, maybe, like Mitt Romney condescendingly telling poor people that they just don't work hard enough. If you don't know what you're talking about, sometimes it's best not to talk.

I would love to hear your own stories about whether or not you feel that working parents in medicine are stymied by lowered expectations or perception bias, and what you all do in your lives to roll with the punches. Because though the natural (or perhaps easiest) reaction is, "Screw 'em! Who cares what people think?" (this is Joe's response, for example) the fact of it is--I do care. I care what people think of me in my career. I care not only about being a good doctor, I care about being perceived as a good doctor. I care not only about having a good work ethic, but about having that work ethic be a key part of how people see me. I care. Maybe not as much as when I was in training (when I wouldn't even have dared to write a blog entry like this at all, for fear that I'd be seen as "whining") but I still care a lot. So until I stop caring, or society changes as I continue to hope it will, I guess I'll keep walking through this field, head up, eyes straight ahead, and try not to look like I'm stealing pumpkins.

66 comments:

Michelle, you raise some very pertinent questions for me. My wife started her family medicine residency this week (I know not July!) because our son is 8.5 weeks old. In terms of the questions you would like answered, my wife is clearly the one to respond, and I want to hear what she has to say about your post. However, I doubt she will find the free time right now to comment here.

My response to your post is more about the overall theme presented by the pumpkin patch metaphor. It worries me that it is victim blaming. Basically, somebody as the victim of prejudice, of assumption of guilty (or in this case lazy doctor) behavior, is expected to act differently because people are assuming things and judging them. I reject that you have to prove you aren't what they assume you to be by having children while being a doctor.

I guess that puts me more squarely in the "Screw 'em!" camp. That being said, choosing to be the trendsetter, to fight the perceptions by refusing to change your behavior is very hard, even if righteous. My wife came home her second day of work crying because she missed us so much and just wanted to be home with her family.

The other question I have is about gender essentialism. Why should we expect fathers who are doctors to be more willing to spend time away from their kids? Why aren't they just as "distracted" from their work? My wife does have to spend time pumping at work, and if I was the doctor in this situation I wouldn't have that burden. But beyond that I see no really differences. We both should get leave to bond with our new son, we both should be expected to respond to a baby emergency, to have a strong desire to get home rather than work late.

So those are my thoughts. If you want to see our cute baby, I recommend you check out my youtube vlog. I am filming him every day and talking about life as a stay-at-home father with a doctor wife. The channel is called vlogerhood.

I care what people think also, but I'm not as good at impression management as you are, so it sort of forces me to be in the "screw 'em" camp whether I want to be or not. How people deal with this issue IS making me rethink specialty choice, because I don't want to have to tiptoe around the fact that I have a child when I start residency / become an attending. Fortunately I like lots of things, so I'm hoping I can figure out something that I like from a medicine standpoint, that works with my research, and that allows me to be open about being a mom.

I have to say that as a med student-parent, I'm already finding things frustrating. Med school has this annoying tendency to tell you logistics at the last possible second, expecting you to be able to drop everything and attend no matter what. The thing is, I CAN usually make it work, but doing so requires more than 12 hours notice (try... 24-48). When I return to MD land in a few months, I think we will have an au pair to help with this sort of thing, but for now I feel like I have a big neon sign flashing over my head saying "LAZY MOM MED STUDENT TRYING TO GET OUT OF DOING HER JOB!!" And also (and this really could be me being paranoid) I feel even MORE pressure to do things perfectly, which is of course impossible, because I want to be seen as capable in spite of the fact that I'm a mom.

What a really remarkable, well-conceived, gutsy post. Thank you for writing it.

As a married female resident in a surgical subspecialty, I definitely feel the work-place womb-watch. And not in a "we're your supportive workplace family who can't wait to watch you grow into the next stage of your adult life" way... no, this is in an "oh, jeez, when are you going to drop this bomb on us" kind of way.

So, in a move to prevent the preemptive lowering of expectations, you can sure bet I keep tight-lipped about any gestational plans I might have.

Tight-lipped or more... I get the questions and prods openly and in public and I find the best response, for now, is "What would I want a baby for?" Shuts them up and gives me peace and quiet for a few weeks. And when I drop the bomb, I'll be sure to reschedule my rotations, so I'm doing the non-surgical stuff during pregnancy. It should work better for me anyway, pregnancy-wise and residency-wise.

I consider myself unlucky that I have very high work ethics. I have been like you at work. Sacrificed and outsourced a lot of things at home. I worked with other women MD's who took advantage and declared their "needs" while dumping their work on others. I had to cover one such woman's patients - slew of calls when she was not at work, or she had ... mommy breakfast at daycare. While my nanny took my kid to post-op appontment. Now that my job is less demanding and I am fully invested in my kids's lives, I regret my early work years. I thank my fate that with 45 h work week I do not miss any educational/behavioral opportunity to help my kids. In short, for me being super-responsible hurt me and my family, and I did not gain more appreciation at work. Except when I left a lot of staff gave me haeartful farewell, still not colleagues.

Michelle, I enjoyed reading your post. I had my son in the middle of my Chief year of OB residency. I felt the exact same pressures you did. I went back at 6 weeks and was angry nearly everyday for having to leave my newborn, having to try not to talk about him "too much" so I didn't seem so unprofessional, etc etc...all in a field that revolves around DELIVERING BABIES.

So after my first full year as an attending, I drastically cut back my hours to work mostly weekends so I could fire the nanny and mother my son. Am I nauseated at times when I think/assume what my partners think of me? Sure. But I am now in the "Screw 'Em" camp when it comes to those thoughts. My patients can have another doctor. My son only gets one mom.

I've never been more at peace with my decision than I am right now. My family life is working for once, and I still get to practice medicine albeit it at a temporarily reduced rate. It might not work for someone else but it works for me. I think the key is finding what works for your family, and not worrying so much what everyone thinks. Easier said than done though when the majority of the medical establishment has a one-track mind when it comes to women docs reproducing, but so it goes.

I'm am MS2 and I will hardly ever tell an attending or faculty member that I have kids. I feel like I have to prove myself beforehand, and then it's okay to talk about it. Their first question is always "where are your kids right now?" LOL!

My husband is a surgery resident. He tells me how he misses me and our kids. When he goes too long (more than 24 hours) without spending time with our daughters he gets sad, depressed and angry. I think that's how a mother might feel under the same conditions. He doesn't cry about it in front of anyone but he sure does mope to me and in the car when he's by himself. He gets angry and bitchy when people waste his time if he is missing us--which is all the time. Surgery resident hours suck as I'm sure you know. I'm about to deliver our next child. He let's people know in no uncertain terms his family comes first. He was asked to represent the program at an event the day before I'm due (I'm not inducing so this baby will come when she is dam well good and ready) and he politely declined to the program director. His priorities are apparent regardless of his gender. Nobody thinks less of him and I'm sure people will bitch when he takes his "one week" off the moment I go into labor but he's let everyone know: "be happy it's one week. If I had it my way it would be a good 3 weeks of FMLA to spend with my family and away from this God forsaken hospital!" And guess what?! My husband is the most decorated, mature and responsible resident of his class. He is always #1 with exams, pimping, evaluations, etc. He is older and this is his second career so he knows how grease the wheels in any environment. Enough bragging...my point is what you should care about is YOURSELF and what your kids think. In 20 years from now your kids will have incredibly strong opinions about your career decisions and YOU WILL HAVE TO LIVE WITH THEIR JUDGMENTS/OPINIONS/FEELINGS. All those jerkoff attendings, co-workers, colleagues? Who knows if you will even be in touch with them in 20 years from now much less care what they thought of you when you had your third baby and wanted to be home more than be at work.

I think it is very brave of you to open up about your dilemma. Of course I can't tell you what to do nor are you asking... but I sure do hope you have minimal regrets with the choices you DO make in balancing career and medicine. Women were given the opportunity to carry children for a reason. Outsourcing the "motherly" role is what some of us have to do sometimes (like getting through training/school/residency) but when you dont have to do it and you still CHOOSE to do it..I promise you will have a LOT of explaining to do not just to yourself but your children. Trust me....your kids are smart and though they seem "fine" now what is the point of having them if you aren't going to be their mother? You started on this path FIRST as a doctor but it's important to keep in mind your kids are only in your house for a very temporary amount of time. It's rare they come home after college and even then it's not the same. You've got one life to live- make it count.

And as we say in this house GO BIG OR GO HOME. I'm eager to see how you balance the family/work dynamic. You certainly are not alone with your thoughts, fears and concerns. Many well wishes sent your way. (I have strong opinions about workaholic mothers because my own mom was/is a workaholic. We don't have a good relationship though she would never admit it).

OK, I get it, but there is a very big difference between outsourcing some stuff at which we suck, and neglecting our kids because we are workaholics. Doing the groceries, laundry, even cooking or making of lunches does not have to be what makes a mother a good mother. There is a lot of space between workaholic and working, and we are talking here about crafting that space so that we are all fulfilled. Making your kids feel like the center of the universe is not actually the best parenting.

You took the words right out of my mouth. This is a great entry because I think it applies to every working mother, not just the ones in medicine. It's disturbing how our workforce discriminates against pregnant women and working mothers in general. I really didn't believe that these things exist until I experienced it firsthand at a high-tech start-up in Silicon Valley. I worked my butt off, running around the office with my big belly, never asked for help or favors, hoping that they can see how hard I work to convert me into a full time employee (as promised). When I was getting ready to go on my maternity leave, they gave me some bs excuse regarding budget issues and also hinted that they're not sure if I would be coming back at all.

I love your blog. I recently started medical school (probably should be studying now!) and I'm a "non-traditional" student who came to medicine from a different career. Starting a career in medicine later in life made me nervous before, because it sure sounds as though training is pretty grueling at times, and if I wait until I'm done I might not have the opportunity for a family. I realize now, that none of my career-changing pre-med male friends had this same fear. They would have kids or they wouldn't, and it wasn't a concern at the moment. All my female friends had numerous discussions about how we might balance a family and a career. I even remember my dad suggesting I go into physical therapy instead of medicine, because I would have better work/life balance. Not that I don't entirely respect physical therapists, it just wasn't what I wanted to do. I love my parents, and they are incredibly supportive, and I think truly want me to have a good life, but I have wandered if they would give this same advice to my brother. Sometimes I think it starts even before you're an actual mother. I know more than one female classmate got asked at a medical school interview if she wanted to have kids someday. I would be shocked if a male classmate was asked the same thing. Frankly, I'm shocked that females would even get asked that, seems like an "illegal" question or something. I don't compare myself to being an actual mother, that is work and responsibility that I clearly do not have, but I already feel like there's an assumption I will take things "easy" (not that I think medicine will be easy) when/if I have a family. I'm sure I read a lot more into these things than I should. But, I guess I still feel like women are groomed to become more of the caretakers, even if the parenting roles are divided somewhat equally in your particular family. I guess I just wanted to add that.

Hi Michelle. I understand you completely, but want to share some positive experiences. I had my daughter the last year of my Pediatric residency, and now I am in fellowship. I returned to work after 4 weeks of maternity, barely staying awake, running through red lights on the road. During this time, I constantly felt guilty and worried about my performance as a doctor, not to mention the unbearable feeling of leaving my child everyday. Unquestionably my mind was on my infant a lot, and I honestly do not feel I was doing well at work. However, everyone in my residency and now in fellowship was/is incredibly supportive of female doctors with children. During my worst self-doubting moments, there were always more senior physicians telling me that I am doing ok, that things well get better as I figure out my role as a mother, and that I can balance having a serious medical career and children. We help each other with childcare, work schedules, time-saving tips. Without a doubt we work hard. It's time to stop being so hard on yourself. We as female physicians need to help each other out and set an example for others joing us. I sincerely believe that women have much to offer as physicians. Doing well at our jobs also fulfills us. A confident, hardworking, fulfilled woman always makes a good mother for her kids, regardless of how much time she spends with them. We in Pediatrics have changed our attitudes, even my male attendings in their 70s made sure I had time to pump in between rounds. We need to make sure the rest of the field catches up.

Maybe this will become an issue in the next few years, or maybe it's an issue now and I'm blissfully ignorant but I feel like I have the opposite problem. I'm an ID physician at a hospital, just had my first baby 18 months ago and am due with my second in 3 more months.

I feel like I'm a recovering workaholic.All through med school and residency I was very comfortable subverting all personal needs and family obligations to focus entirely on work, and in a way I was lucky that I could afford to be completely immersed during that time in my life. My parents and siblings were healthy, I was single, I didn't have kids. If I was in the hospital most of the time and reading journal articles the rest of the time, it was fine.I don't have to tell you that friendships suffered, my family (although understanding) got neglected, and I started some bad habits - like thinking the job couldn't be done well unless it was all encompassing.I got a reputation for being reliable and hardworking. I got stuff done and didn't complain, so more work was given to me.Then during fellowship I started dating my husband, and he did not accept me constantly blowing him off or cancelling plans due to work related issues. He made me see that there are true emergencies that warrant cancelling plans - I am a doctor after all - but if they're happening 5/7 days a week then something is either wrong with our call schedule or my ability to prioritize.That was the first time I really recognized that my non-work obligations needed priority, too. It was around this time that someone told me that story about 'putting the rocks in first'. I realized that my work would always expand to fit whatever time and space I gave it. There's always another patient family member I could talk to, always another lit search I could to just to be SURE I wasn't missing anything. At some point I had to finish the consult note and go home.

So fast forward to my current job, I still work hard and get stuff done and I continue to get work given to me. Since I had my baby my priorities have shifted - I no longer want to stay up til 3am finishing a data analysis then get up at 630am to round on hospital patients. I want to eat dinner with my family and read stories to my daughter. I want to sit on the couch with my husband and joke about our day in the evenings. My family doesn't consider it acceptable for me to come home at 9pm on a regular basis. And neither do I.So while my company and bosses continue to expect great things from me and give me opportunities for advancement, I've started saying no thank you. I'm putting the rocks in first. The biggest rock is excellent patient care, and I think I still do that, but now I've learned how to do it and leave room for those other rocks - my husband and daughter(s).My view of career success has changed. Success looks less like a file cabinet of published articles and more like getting home by 630pm on a regular basis.But no one has adjusted their expectations of me which means I've had to say 'no' a lot more than I used to.

My previous work habits were not sustainable. Now I tell the trainees I work with that it's better to be a very good doctor for a 30 year career than to be an exceptional doctor for 5 years, burn out, and quit. It's a marathon, not a sprint. Ignoring self care is actually no good for anyone.

This is interview season, and I am applying in Anesthesia, and I just realized how nervous I was to admit I had a child. However, I'm on an away rotation, and the words just came rolling out of my mouth, and before I knew it - an attending and I were comparing toddler pictures.

I'm not sure this is right or wrong - but I don't care. This is who I am. I am a MS4 with unbelievable board scores, a great resume, a strong work ethic, and a toddler. And I'm not going to hide it this season.

I can't believe for a second I thought about doing that. I'm going to be a physician, but I am also a mother, and I will always be BOTH of those things. And to my son- I am a mom who works weird hours and owns a stethoscope, which is fun to play with.

2) I don't know if peds is different because we're around kids all freaking day, but in my residency program we're happy when our residents start or grow their families. My intern year we had ~10% of the class out on maternity leave at one point and the chiefs never had to draft people into extra coverage, the rest of us just volunteered because getting to spend time with your newborn is a Good Thing and not something to be begrudged. We have residents who bring their kids to all sorts of hospital events including intern recruitment and it is never a problem (at least not for us; one restaurant did ask us not to bring kids again - we never went back).

3) We've had several attendings pregnant recently and of all the gossip I hear, none of it is about them shirking their duty; frankly most of what i hear is people trying to talking them into taking lighter call/service schedules in the 3rd trimester.

4) Where my experience has been as dismal as some of your observations has been paternity leave. We have none. Your options are to try and swap services to burn through your 3 weeks of annual leave (moms but not dads are allowed to borrow against vacation in future years and to ditch rotations not required for graduation so they can get closer to 12 weeks without much trouble) or to take a leave of absence from the program under the same process you go through when you have a psychiatric breakdown.

I love your blog, and I have so much respect for what you say--thanks for inspiring me (lawyer, mom of 2 yr old son) to keep it up.

You allude to this, but: I think the problem is not with the clumsiness of the metaphor, but rather that the metaphor doesn't apply at all. Who says you're in someone else's pumpkin patch? Ef that noise. I say after school, grad school, having babies, etc, you have your own pumpkin patch. Which is not to say ignore what people think; it's only to say recognize that those watchers/judgers also know you've accomplished a lot.

I will say in my experience--having a baby in law school, and now having a toddler while completing a federal clerkship--my colleagues and classmates have always said how impressed they are, and never the opposite (even as I was always self-conscious that I was being respected less).

So, I hear you. But you are not on their turf. They are, equally, on yours.

Do you think in 100years (lets hope less!) that people everywhere will be laughing at how mothers who worked use to get stressed over all the above scenarios?? (No disrespect AT ALL to any of them from me!!) And while this seems irrelevant- -it isn't really - especially if some female physicians out there from an era gone by could comment...I'm sure the perception has changed a teeny bit - and will continue to so while we battle it out.... Think back even 50 years and women in a lot of professions had to fight so hard to be there at all. More so if they had coloured skin or an ethnicity different to the country they worked in... Mixed race couples,mixed race children, being gay, having a nose ring, having a tattoo in a visible place, allowing your husband in the delivery suite,dads getting maternity leave, dads staying home, female PrimeMinisters,Black Presidents, female Governors,married with children female Surgeons... ...the list goes on and on...its all a sign of the times. Hard work when you're in the middle of it, not realising you're paving the rules for the future.... Ditto to technology (although that is tending to move somewhat faster than gender equality sadly!..how many cell phones did you see in the 80's? Text language..wtf? lol!Cameras,in a telelphonic device??! Don't even go there with digital cameras vs.film! ) Its all a sign of the times, do whatever the heck works for you...because the tide has shifted, and will continue to do so. I really believe perception is changing, and those who slow it are funnily enough the ones most jealous of our situations.. Go with your flow, enjoy what talents you have worked to have, enjoy whatever children you have created and those around you will follow your tide...With love, Absolutely Positively in the Screw'Em Who Cares What They Think Category! xx

I have to echo the few that have reported good experiences with becoming a mother. I waited until I finished residency and was 2 years into my current position before I had a child. I honestly cannot imagine having had a child during med school or residency. Kudos to all the moms (and dads) who manage that. I do not know that I would have made it through training with a child at home.

However, as a Pediatric Hospitalist at a community hospital, I feel like I have the best of both worlds. As a previous poster commented, I may be blissfully ignorant, or things may change in the future, but right now, I feel incredibly lucky. I work 24 hour shifts, and 7-8 shifts a month is full time. The days and nights away are only manageable because I have a fantastic husband who has been able share duties with me. I am able to be home a lot, and do not have to bring work home with me. Being in a community hospital, I have no pressure to publish or to meet any particular deadlines or quotas. And most of the nurses I work with are also working mothers, which provides a built in support network.

I say this all not to boast, and not to promote hospital medicine as the best model ever, (though I think it is!) but to say that I think things are getting better for working moms. As another previous poster mentioned, in pediatrics there are a lot of women, and a lot of working moms. We, as a specialty, have been through the process of figuring out how to make it work. It isn't perfect for everyone, but I think it is getting better. As more women become more prominent practitioners in other areas of medicine (and other careers as well), I think the perception bias has to get better.

Hopefully, by the time our children become parents, we can tell them about the difficulties working motors faced, and it will be a quaint memory! And good luck to those of you that are laying the groundwork today.

I just don't get all the hand wringing. If you have a family and love them and want to spend more time with them, work part time. Who cares? Both my husband and I are docs and we BOTH work part time. We don't even have kids. We just enjoy spending time together, have other interests, and don't have an expensive life-style, so we can afford to work part time. When other MDs realize what we're doing, they act like it would never occur to them in a million years (and it probably wouldn't) but say they're "envious" and "I wish I could do that." Most can.

As an aside: I remember a male colleague 20 years ago (when I still worked full time) insisting that he always get Xmas off on the call schedule because he was the only one who had kids. I told him if he expected Xmas off every year, he should have been a banker, that I might not have kids, but I had other family I wanted to spend time with.

I am so glad you are saying this publicly. In my law firm and in my area, enough people have voiced their concern about negative attitudes toward working moms that, even if attitudes haven't changed overnight, people are conscious of the unfairness of these perceptions. That makes a big difference. And when I say "people," there are a lot of men out there, particularly younger men, who believe in gender parity, want to be involved parents themselves, and are completely on board. I think it takes a lot of people, at all levels, being willing to say, "Hey, I am a professional and am serious about my work, AND I am a parent. Judge me on how I perform, not on what you think about people like me"... and then having someone in the organization who is accountable, whether willingly or as a result of pressure, for making sure people are evaluated and treated fairly.

You feel this way because you are a product of our culture where women try to fix everything and make people happy and it is more allowed and accepted for a man to say 'screw em'. Also our culture devalues women and work women do and being a mother gives this prejudice a hook to snag in defense of this prejudice. It is not about medicine. The same is true across the whole work force. And it is only worse in many other cultures. At 68 now I once thought things would be better for my daughter's generation. But it isn't. My hope now is for my great grand daughter's generation, and I am not sure even then that things will be better. There is a tremendous backlash against working women, women doing well in school, women having independence and control of their own assets and lives. You are NOT imagining it either. It is real. And, it is powerful and dangerous to women. It is bigotry and prejudice and the war/problem will go on until men like your husband are the majority, not the minority, among men in our society. Thank you for posting. Your children are beautiful and I really appreciate the time and effort you put into your medical work as well as your blog. You give me hope when I am discouraged.

You do have a perception problem...but that's because there is a reality problem. It should be acceptable for physicians of all stripes to have personal responsibilities outside of their jobs. There simply needs to be systems and a culture in place that doesn't require the same person to be in the same clinical setting at all times- yes, there will be handoffs and coverage and people need to communicate well but that's about it. Both healthcare staff and physicians need to accept that they are, in fact, replaceable. If we can get over that hump, then it's okay whether or not you have children or aging parents or whatever. You shouldn't have to overcompensate for being a regular adult.

I think pediatrics is a good example that things are changing- we've had gender parity for a while now in med school enrollment, so one can hope that other fields will start to catch up. And yes, it also helps if men are changing too- wanting to assume more responsibility in family matters, and having a greater need to do so because they're married to other physicians.

In my husband's group, they all have young children. Yes, two of the three women work fewer hours and see fewer patients- but no one minds- they are paid less. The third is a single mom (everyone respects her even more and tries to be more supportive). And no one perceives these women as any less, or not pulling their weight-- if anything, the men, including my husband, know they're damned lucky that they have wives who take care of the lion's share of family responsibilities, that dinner is on the table when they get home, unlike their female colleagues.

Anyways- this doesn't really answer your question or solve any problems...can only hope that with more women in medicine, both men and women will be more supportive of each other.

Very well written and expressed, Michelle! It most definitely is easier to not care what people think, but the problem is that so much of medicine is based specifically on perceptions- and often times, unless you're the world's expert in something, these perceptions can definitely affect work relationships- and even referral patterns. Reputation is almost everything in this field, especially for subspecialists. And the problem with perception is that people form them instantly (I believe this is human nature, but also part of our training, to form decisions/judgements fast- after all, people's lives depend on this "instant" judgement, certain specialities more than others, of course...), so it's hard to change a perception that has already been there.

I completely get what you say about overcompensating... in my fellowship program, it's been an uphill battle for me. There is a current fellow in the class above mine, who, actually, unfortunately, has "confirmed" all the perceptions above- and thus, has made it difficult for herself in the future and also for everyone else. She asks for special favors (begging off difficult rotations, calls, etc, refusing to take certain holiday call), is always the first to leave clinic (with remaining patients), first to leave endoscopy (with remaining patients), complains about the work all the time, and is quite unreliable. Unfortunately, when other fellows mention this, she goes to the administration and cries; the rest of us are then asked to be more considerate and helpful (aka, do her difficult rotations, take her calls, see more patients, etc). So the rest of us- most of us also parents, including myself- end up having to pick up all the extra work- and we, especially the two of us who are also new mothers- end up overcompensating, because you never want to be "that mom" who couldn't "get it all done". Like you've said before, it's not easy, and it's definitely tiring- but as long you complete the work, it shouldn't be an issue at all, regardless of whether you're a parent or not. Slackers are just slackers, but parenthood should not ever be used as an excuse, because if that happens, it ends up leading to a lot of resentment.

Can I take this one step further? I have a 13 month old daughter and am doing my prelim year for anesthesia and I find myself having to justify my choice of specialty because when attendings ask what specialty I'm pursuing, they assume I want to do anesthesia because it is has a nice lifestyle. I find myself overcompensating when I explain to them that I actually LOVE THE FIELD, so much so that I considered choosing a different specialty. Literally. Just so I could avoid those "that will be a nice mommy job" comments that cut me down to my core. I don't think it gets more ridiculous than that.

Thank you for this thoughtful blog post! I am not in medicine but have heard similar stories from working mom friends in general. If their kids are sick, they feel like they must lie in order not to be viewed as "slackers". It doesn't matter how many hours they work, how many awards they win and/or if they go to work sick themselves. The same is not true of any other employee or any other reason other than children to take time off work. And these stereotypes and perceptions are NOT in their heads. I work in a non-profit organization that advocates for mothers and families, and we have come across study after study that mothers face all kinds of discrimination in the workplace including less likelihood of being hired and unexplainable wage gaps compared to non-mothers (including fathers). Here is more information if interested: http://www.momsrising.org

I don't think you are oversensitive. I think those perceptions you listed definitely exist. (Unfortunately, the "screw them" women help perpetuate those generalizations, and then women like you and me feel obliged to "overcompensate" so that we are not seen in the same light.) I am like you and try to be a "team player" whenever possible. Unless I am deathly sick, I never take sick days. When I was pregnant, I wanted OB to follow me (even though I was low risk) but eventually "settled" on a family doctor only because the family doctor worked weekends which meant I did not have to take time off. I went into work even when my toddler was struck with pretty bad pneumonia and high fever, and I was worried sick. (Fortunately, family was there to help out.) I thought the days of "proving myself" were over the moment I graduated from residency and secured what is essentially a tenured position but not so much.

And just think, in a few years, I will have to consider how my child or his school or other parents perceive me if I miss a field trip, play, PAC meeting fundraiser, etc because I am on call...yet again. I would probably overcompensate by baking more cookies for the next sale even if it means I am up until 2am doing it...or letting my kid stay up late eating ice cream.

It sounds more and more like I will be overcompensating wherever I go. :)

I've commented this a few times but your blogs are most enjoyable to read. You are like an old friend yet I don't know you at all...it is the most unusual feeling. Keep them coming!

Background: I'm a family doc in Canada, 2 kids, one born in residency and the other in my second year of practice when I was working as a locum.

I don't feel like the expectations are lower. And I don't feel like I have to be superwoman to meet most patient's expectations. It's actually my colleagues' expectations that can be challenging, as it's pretty much expected that you work all day, go home and do the family thing, and then work another 2 or 3 hours every evening, doing paperwork. I try not to do that and I know some of my colleagues think I'm a slacker.

Most patients totally get the work-life balance thing, although I certainly had some snarky comments from patients when I was pregnant the second time. Mostly about how many doctors get pregnant and 'abandon' their patients. My stock answer was mostly, "Yup, darn us having personal lives, eh?" The vast majority had the good grace to look embarrassed at that point.

I had my first baby during the last week of my breast imaging fellowship, so the first maternity leave was "on me." I started part-time with the understanding that I would never be interested in more days or call. Two years later, the second maternity leave, which was 5 weeks without baby, then one week working with baby, was on my partners. I have since worked for 13 years without ever making excuses or apologies.

My alma mater (Smith)once had a seminar on Women in Medicine, and the best thing I took away from that was never to apologize. Work with the attitude that they are lucky to have you, for whatever time you are giving them, and then, MAKE IT SO. I know I'm lucky to have the terrific partners I have, but they are equally lucky to have me. I have always had childcare that met or exceeded my needs, and now have morphed the nanny to meet more of my needs, since the kids are hardly even there.

My kids are happy, well-loved, well-adjusted, and understand that the world does not revolve around them. Their needs, (as defined by their parents,) will always be met.

Thanks again, Michelle, I have always loved your sense of humor and honesty.

I'm a 2nd-year fellow in Neonatology, and I have a 3-year-old son. I was one of those people who knew I didn't want to have kids during residency but also didn't want to wait too long afterwards, since I'm a couple years older then my classmates. Now my husband and I are thinking about a second child, but I am in a similar situation to one of the previous posters-- one of our 3rd-year fellows is currently pregnant, and she is in charge of making our call schedule for the year. Coincidentally, she has managed to arrange most of her calls for the first half of the academic year-- before she has the baby. Which means that the second half of the year is going to be quite call-heavy for the rest of us. The ironic thing is that if she had just come right out and asked us if we minded taking fewer calls now, knowing that we would have to take more in the second half of the year, I think most of us would have been OK with it. It's the (for lack of a better word) sneaky way she went about it that has painted her in a bad light. Now if I become pregnant in the next year, then I'll be the 3rd-year fellow making the call schedule, and I already feel like I will have to bend over backward in order to avoid the perception that I'm manipulating the schedule to suit my needs/wants.

Anyway, Michelle, your point about your "aggressively pleasant" personality really resonated with me. I find myself falling into the same trap, although I never associated it with being a mother. More just that the NICU is almost an all-female environment (attendings, nurses, RT's, etc) and women can be really tough on each other. It's really interesting when a male peds resident rotates through the unit-- he can be the slowest, most clueless resident ever, but the difference between the way he is treated and the way female residents are treated is really striking. But's that another topic entirely!

I've been a family medicne doc for 11 yrs. I had a baby 3 yrs and then again 5 yrs after joining an all male practice. Initially it was very hard because the culture of medicine is that having needs outside of medicine is a weakness. Heaven forbid you should need 6 hrs of sleep or actually need to take time off for your cholecystectomy! When I presented my plan for maternity leave one of my partners told me he knew a woman who came back to work a week after delivery. So there was definitely this sense of having to go above and beyond just to feel like I wasn't hurting the group. After getting divorced (nothing to do with the work schedule) I changed everything and refocused on being the mom I want to be and being a good doctor and realizing I don't have to sacrifice one to be the other. So screw the medical establishment! My patients and my family are happy and so am I!

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